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Occupational therapists’ use of
occupation-focused practice in
secure hospitals
Practice guideline
College of Occupational Therapists
Specialist Section – Mental Health, Forensic Forum
COT Implementation toolkit/CPD Session
© 2012 College of Occupational Therapists.
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Key objective of guideline
To provide specific recommendations to
support the use of occupation-focused
occupational therapy in secure hospitals.
The guideline is relevant to high, medium and
secure hospitals.
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Recommendation areas
Model of Human Occupation Framework:
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Volition
Habituation
Performance capacity
Environmental considerations
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© 2012 College of Occupational Therapists
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Methodology
1. Guideline development
group established
5. Critically appraise articles
6. Development of practice
guideline recommendations
9. Published by
COT 2012
COT Implementation toolkit/CPD Session
© 2012 College of Occupational Therapists.
2. Guideline scope defined
involving stakeholders
4. Screen findings
3. Literature search
7. Peer review, stakeholder and
service user consultation
8. Final draft approved by COT
Practice Publications Group
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Evidence-based recommendations
Recommendations are based on the evidence
available within 34 critically appraised papers.
Each recommendation is assigned:
• A strength scoring 1 or 2 (Strong or Conditional)
• A quality grading A, B, C or D
(High, Moderate, Low or Very Low)
COT Implementation toolkit/CPD Session
© 2012 College of Occupational Therapists
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Volition
Volition
1. It is recommended that occupational therapists always take into
account the gender specific needs of patients with whom they are
working.
(Baker and McKay 2001, C)
1C
2. It is recommended that occupational therapists consider the
occupational life history of patients, including that at the time of the
index offence, and its influences on occupational performance, life
satisfaction and criminogenic lifestyle.
(Lindstedt et al 2005, B)
1B
3. It is recommended that occupational therapists establish as part of
their assessment, patients’ perspectives of their occupational
performance and social participation, and work with those perceptions
in planning care.
(Lindstedt et al 2004, B)
1B
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Volition
4. It is recommended that occupational therapists work collaboratively with
patients in identifying and planning their care pathways.
(Clarke 2002, C)
1C
5. It is recommended that occupational therapists recognise the specific
intrinsic value of occupation to individual patients.
(Craik et al 2010, C)
1C
6. It is recommended that occupational therapists facilitate meaningful
occupational choices for patients.
(Craik et al 2010, C; Cronin-Davies 2010, C; Mason and Adler 2012, C;
Morris 2012, C; O’Connell et al 2010, D; Stewart and Craik 2007, C)
1C
7. It is recommended that occupational therapists ascertain patients’
aspirations towards paid employment at the earliest opportunity, and
during rehabilitation.
(McQueen 2011, C)
1C
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Habituation
Habituation
8. It is recommended that occupational therapists consider the patients’
roles, (past, present and future) within treatment planning and
interventions.
(Schindler 2005, C)
1C
9. It is recommended that occupational therapy facilitates a range of
interventions that enable patients to engage in structured and
constructive use of time throughout the week, including weekends and
evenings.
(Bacon et al 2012, D; Castro et al 2002, C; Farnworth et al 2004, C;
Jacques et al 2010, D; Stewart and Craik 2007, C)
1C
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Performance capacity
Performance capacity
10. It is recommended that occupational therapists routinely used
standardised outcome measures to assess and demonstrate
patients’ progress.
(Green et al 2011, C; Clarke 2003, D; Fitzgerald 2001, C; McQueen
2001, C)
1C
11. It is recommended that occupational therapists consider supported
employment or prevocational training as part of occupation-based
intervention opportunities for patients.
(Garner 1995, D; McQueen 2011, C; Smith et al 2010, D)
1C
12. It is recommended that occupational therapists consider the use of
healthy living programmes and exercise as activity to benefit health
and wellbeing.
(Bacon et al 2012, D; McQueen 2011, C; Prebble et al 2011, D; Tetlie
et al 2008, C; Tetlie et al 2009, C; Teychenne et al 2010, C)
1C
13. It is suggested that occupational therapists include social inclusion
programmes as part of their intervention to improve occupational
functioning.
(Fitzgerald 2011, C)
2C
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Environmental considerations
Environmental considerations
14. It is recommended that occupational therapists fully value the therapeutic
use of self as being integral to the positive engagement of patients in
occupations.
(Mason and Adler 2012, C; Tetlie et al 2009, C)
1C
15. It is recommended that occupational therapists ensure that risk
assessment is a dynamic process, in which judgements are made on an
on-going basis in collaboration with patients and members of the
multidisciplinary team.
(Cordingley and Ryan 2009, B)
1C
16. It is suggested that occupational therapists recognise the role and
contribution of carers in the recovery of patients.
(Absalom et al 2010, C; Fitzgerald et al 2012, D)
2C
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Environmental considerations
17. It is recommended that occupational therapists consider the impact of the
environment on quality of life and occupational engagement.
(Craik et al 2010, C; Fitzgerald et al 2011, D; Long et al 2008, C; Long et
al 2011, C; Morris 2012, C)
1C
18. It is suggested that occupational therapists liaise with a range of
community services to facilitate replication of patients’ pro-social
behaviours developed during an inpatient stay.
(Elbogen et al 2011, D; Lin et al 2009, C; Lindstedt et al 2011, C)
2C
19. It is recommended that occupational therapists demonstrate their
competencies (skills and training) to facilitate identified therapeutic
groups, enhancing the confidence and participation of patients.
(Mason and Adler 2012, C)
1C
20. It is recommended that occupational therapists articulate, to patients
and the multidisciplinary team, their role and the contribution of
occupational therapy to the overall treatment performance.
(Cronin-Davis 2010, C)
1C
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Impact of practice guideline for you
• Challenges / affirms your current practice.
• Informs your practice.
• Provides evidence to support your practice
(completion of Audit Form).
• Provides a vehicle for you to justify your
practice.
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Impact of practice guideline for
managers
• Provides evidence of the need for
occupation-focused occupational therapy for
adults in secure hospitals.
• Provides a structure to audit the work of
occupational therapists within the service to
improve service quality.
• Provides a vehicle for justifying service
provision.
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Impact of practice guideline for
patients
• In being adopted by services and
occupational therapists, the guideline should
improve the consistency and quality of
intervention for users of services.
• Gives assurance that practitioners use the
available evidence to support interventions.
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Impact of practice guideline for
commissioners
• Articulates the need for occupation-focused
occupational therapy interventions within
secure hospital services.
• Can help educate commissioners to identify
learning needs for the workforce.
• Associated audit form provides a mechanism
to review service delivery in accordance with
the evidence.
COT Implementation toolkit/CPD Session
© 2012 College of Occupational Therapists
www.COT.org.uk
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Help from COT/BAOT
• Link up with your BAOT networks to gain advice and
support. Find out through your BAOT regional
group or the COT Specialist Section you belong to
whether they have resources that can help you.
• iLOD is designed to be a one-stop shop for all your
CPD needs and it was developed to make it simple
for BAOT members to meet the HCPC’s baseline
standards for CPD.
If you are having difficulties or need support contact
professional.enquiries@cot.co.uk
COT Implementation toolkit/CPD Session
© 2012 College of Occupational Therapists
www.COT.org.uk
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